腹腔镜肾上腺手术中转开放手术及合并症分析

目的　分析腹腔镜肾上腺手术中转开放手术原因及合并症处理。　方法　对 19例腹腔镜肾上腺肿瘤切除术中 8例转开放手术的原因及合并症进行分析。　结果　 8例手术中转开放手术患者包括右肾上腺中静脉出血 1例 ,胰尾遮挡肾上腺肿瘤暴露困难 1例 ,左肾上腺囊肿被副脾遮挡1例 ,手术过程中气腹不满意 2例 ,未找到病灶 2例 ,腹膜后镜手术穿刺时引起腰大肌出血 1例。术后高热 3例 ,其中腹膜后脓肿 1例 ,反应性胸膜炎 1例。　结论　腹腔镜和腹膜后镜手术需要一定经验和熟练的配合 ,初学者操作易出现合并症 ,导致手术失败。腹膜后镜手术治疗肾上腺疾病更简便     

雄激素剥夺条件下阻断自噬增加LNCaP细胞凋亡

Objective To investigate the change of apoptosis in LNCaP cells after inhibition of autophagic process under androgen removal conditions. Methods The autophagic level was deter-mined by using confocal microscopy and RT-PCR. The DAPI staining was used to indicate the apopto-sis of LNCaP cells after inhibition of autophagic by 3-MA. Also, Z-VAD-FMK was used to extend the apoptosis results. Results ①Androgen deprivation led to increased autophagy in LNCaP cells. LN-CaP cells cultured in complete medium(CM) presented low autophagic process with 1.9 scores. After 24 hours, the punetate GFP-LC3 structures were accumulated in the cells cultured in serum-free medi-um (SF)(2.64 scores). In contrast, the number of punctate GFP-LC3 remained at a very low level (1.85 scores), when cells were incubated with DHT in SFA(serum-free medium+DHT). Statistical analysis showed the significant difference between SF and SFA (P<0.01). Semiquantitative RT-PCR was employed to examine the mRNA expression of LC3. Indeed, cells grown in the medium without serum had a higher LC3 mRNA expression with the highest at 12 hour time point as compared with the cells grown in CM. DHT treatment reduced the level of LC3 mRNA. ②Blockage of autophagy by 3-MA increased the apoptosis of LNCaP cells. LNCaP cells in SF and SFA just presented a basal level of apoptosis, which is (3.19±1.09)% and (3.01±0.33)% , respectively. Under androgen-free con-ditions, inhibition of autophagy by 3-MA could increase apoptosis significantly(10. 90±2.91%). While Z-VAD-FMK, a pan Caspase inhibitor, was able to suppress this apoptotic process to the level of (1.16±0.52)%, which was statistically significant(P<0.01). Conclusions Androgen removal can lead to the increase of autophagy in LNCaP cells. Moreover, inhibition of autophagy promotes the occurrence of apoptosis.     

神经淋巴瘤病一例报告

神经淋巴瘤病(neurolymphomatosis,NL)是指非霍奇金淋巴瘤浸润周围神经系统,临床表现以周围神经损害为主,病理检查可以发现肿瘤细胞在神经组织浸润伴随有髓神经纤维轴索或髓鞘损害.本文报道1例通过神经活检证实的神经淋巴瘤病.     

Lymphoceles: imaging characteristics and percutaneous management

Twenty-five patients who had lymphoceles underwent sectional imaging and interventional radiologic procedures. Viewed using sonography, lymphoceles were hypoechoic to anechoic, occasionally with internal septa and debris. Low numbers (occasionally negative values) were observed using computed tomography (CT); these numbers strongly suggest the diagnosis of lymphocele. Calcification was observed on CT images of one patient. Diagnostic aspiration revealed tan to yellow fluid containing many lymphocytes; pathognomonic fat globules were observed in four cases. Malignant cells were found in two collections, an unusual occurrence. Therapeutic needle aspiration and short-term catheter drainage were usually unsuccessful (only one of five patients [20%] was cured). Long-term (1-5-week) catheter drainage cured 11 of 14 patients (78.6%). Sclerosing agents may have been beneficial for lymphocele obliteration in three of four patients. For most patients, lymphoceles may be diagnosed and treated successfully using radiologic means.     

CT引导经皮置钉治疗病理性骶髂关节疼痛

背景大多数后路骨盆和骶髂关节转移肿瘤患者为临终患者,其治疗目的主要是姑息治疗和减轻疼痛,提高患者生活质量.目的探讨在CT引导下经皮微创技术置入空心拉力螺钉治疗病理性骶髂关节疼痛.设计前后对照的临床试验.地点和对象在浙江省宁波市第六医院完成.8例骶髂关节转移肿瘤患者,男4例,女4例;年龄12～83岁.方法对8例骶髂关节转移肿瘤患者试行在CT引导下经皮微创技术置入空心拉力螺钉稳定病理性骶髂关节不稳.术前和术后进行Enneking疼痛评分.主要观察指标手术前后疼痛恢复情况.结果经2年5个月随访,患者疼痛减轻,平均3.2分,范围0～5分.结论CT引导下经皮置入空心拉力螺钉能有效缓解病理性骶髂关节不稳所致的疼痛.     

还原型谷胱甘肽对糖尿病大鼠肾组织非酶糖基化影响的试验研究

目的探讨还原型谷胱甘肽对糖尿病大鼠肾脏的保护作用及其可能机制。方法以链脲佐菌素诱导糖尿病大鼠模型，给予还原型谷胱甘肽、盐酸氨基胍单独或联合治疗8周，以荧光分光光度计测定肾皮质荧光值即糖基化终末产物（AGEs）含量，行肾组织PAS染色测定平均肾小球截面积（MGAl及体积（MGV），放免法测定尿白蛋白排泄率（UAER），同时检测糖化血红蛋白（HbAIc）、血清肌酐清除率（Cer）、肾重／体重比值、血糖水平等。结果8周时，各组糖尿病大鼠Ccr、UAER、MGA、MGV、肾重／体重比值、AGEs含量均较空白对照组明显增加（P〈0．05或P〈0．01）。还原型谷胱苷肽、盐酸氨基胍单独或联合治疗组Cor、UAER、MGA、MGV、肾重／体重比值、AGEs含量均较糖尿瘸对照组明显降低（P〈0．05或P〈0．01）。结论还原型谷胱苷肽及盐酸氨基胍均可减少肾组织糖基化终末产物生成，对糖尿病大鼠肾脏具保护作用。     

三个候选基因多态性与糖皮质激素性骨质疏松症关联的研究

目的探讨护骨素（OPG）A163G、瘦素受体（LEPR）Gln223Arg和过氧化物酶体增殖物激活受体γ（PPARγ）C161T3个单核苷酸多态性（SNPs）与糖皮质激素性骨质疏松症（GIO）的关系。方法选择哈尔滨医科大学附属第一医院肾内科患者采用限制性片断长度多态性法,在208例健康对照组、168例非GIO组和104例GIO组中分析A163G、Gln223Arg和C161T多态性的基因型分布;应用双能X线骨密度仪（DEXA）测定股骨、腰椎等部位的骨密度。结果在单基因研究中,GIO组患者与健康对照组比较,A163G和C161T基因型和等位基因频率差异有显著意义（P〈0.05）;采用多基因联合分析,OPGGG纯合子中,PPARγTT纯合子GIO患病率显著增高（OR=2.04,95%CI1.26～3.67,P=0.02）。结论OPG A163G和PPAR γC161T多态性可能与GIO的发病相关;在GIO人群中,OPG A163G和PPAR γC161T多态可能有协同作用。     

护骨素基因A163G多态性对应用糖皮质激素患者骨量的影响

目的探讨应用糖皮质激素患者护骨素（osteoprotegerin，OPG）基因启动子A163G单核苷酸多态性与骨密度和骨生化指标的相关性。方法应用聚合酶链反应-限制性片断长度多态性（PCR-RELP）方法测定哈尔滨医科大学附属第一医院肾内科208例正常健康人（Ⅰ组）和272例应用大量糖皮质激素的患者（Ⅱ组）护骨素基因启动子A163G的基因型；应用双能X线骨密度仪（DEXA）测定股骨、腰椎等部位的骨密度，同时检测骨代谢生化指标。结果启动子h163G发现AA、AG、GG3种基因型，各基因型分布频率在两组间差异无显著性（P〉0．05）；将应用激素组患者分为骨质疏松组和低骨密度组，各基因型在两组间差异有显著性（P〈0．05）。Ⅱ组各基因型之间腰椎、股骨颈的骨密度差异有显著意义（P〈0．05），分别为；腰椎从（1．04±0．12）g／cm^2、AG（0．98±0．09）g／cm^2、GG（0．83±0．08）g／cm^2，股骨颈从（0．84±0．09）g／cm^2、AG（0．75±0．07）g／cm^2、GG（0．69±0．09）g／cm^2。经年龄、体重指数等因素校正后，差异仍有显著性（P〈0．05）。Ⅰ组的各项指标和Ⅱ组的其他指标在不同基因型间的差异均无显著性（P〉0．05）。结论OPG基因A163G基因型在两组间差异无显著性，它与肾小球肾炎的发病无关；A163G基因型在骨质疏松组和低骨密度组之间有明显差异，它与糖皮质激素性骨质疏松症的发病有关；OPG基因A163G多态性与应用激素患者腰椎、股骨颈的骨密度明显相关，等位基因A可能是骨量的保护因子，它可能与应用糖皮质激素后骨量的丢失有关。     

5-脂氧合酶激活蛋白抑制剂MK886对人食管癌细胞系增殖和凋亡的影响

目的 5-脂氧合酶活化蛋白（FLAP）抑制剂MK886对人食管癌细胞系（KYSE-150和TE-3）增殖和凋亡的影响及作用机制。方法用2.5、5、10、20、40和80μmol/L的MK886干预体外培养的KYSE-150和TE-3细胞;xCELLigence RTCA系统实时测定细胞增殖抑制率,同时确定半数抑制浓度(IC₅₀)。流式细胞测量术检测食管癌细胞的细胞周期。Western blot检测细胞凋亡和自噬相关蛋白的表达。结果人食管癌细胞系（KYSE-150和TE-3）的增殖抑制率随着MK886浓度增加而增强（P<0.05）,KYSE-150组的IC₅₀浓度为29.11μmol/L,TE-3组的IC₅₀浓度为27.47μmol/L。当MK886浓度增加至25μmol/L时,食管癌细胞G₀/G₁期滞后增加明显（P<0.001）,MK886处理浓度增加到50μmol/L时,食管癌细胞G₂/M期增加明显（P<0.001和P<0.05）...     

精神障碍患者自我面孔识别的行为特征与异常神经活动

自闭症、精神分裂症、抑郁障碍等精神障碍患者均表现出自我面孔识别缺陷。行为特征包括识别困难、错误率更高、反应速度更慢、速度加工优势消失、知觉加工受损及认知评价与情绪反应失调等;神经活动异常出现在自我面孔识别的各个加工阶段,涉及面孔结构编码相关的枕颞皮层、自我参照加工相关的皮质中线结构、认知控制有关的额顶控制网络以及情绪加工相关的脑岛等脑区。元分析结果揭示精神障碍患者额下回、内侧前额叶、海马旁回和脑岛等脑区活动存在异常。未来研究应结合时间和空间信息数据并关注脑区间协同功能的损伤,关注各类精神障碍患者自我面孔识别的共同特征及其独特性,并发掘自我面孔识别在精神障碍早期诊断中的潜在价值。